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Mansour M, Augustine M, Kumar M, Butt AN, Thugu TR, Kaur P, Patel NJ, Gaudani A, Jahania MB, Jami E, Sharifa M, Raj R, Mehmood D. Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape. Cureus 2023; 15:e50539. [PMID: 38222136 PMCID: PMC10787848 DOI: 10.7759/cureus.50539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.
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Affiliation(s)
- Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | | | - Mahendra Kumar
- Medicine, Sardar Patel Medical College, Bikaner, Bikaner, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Thanmai Reddy Thugu
- Internal Medicine, Sri Padmavathi Medical College for Women, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, IND
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | | | - Ankit Gaudani
- Graduate Medical Education, Jiangsu University, Zhenjiang, CHN
| | - M Bilal Jahania
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Dalia Mehmood
- Community Medicine, Fatima Jinnah Medical University, Lahore, PAK
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Liu X, Wang Y, Shen L, Sun Y, Zeng B, Zhu B, Dai F. Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey. BMC Geriatr 2023; 23:745. [PMID: 37968629 PMCID: PMC10647084 DOI: 10.1186/s12877-023-04438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans. METHODS This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005-2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the "usual or most common type of stool" by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency. RESULTS Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week. CONCLUSION Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.
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Affiliation(s)
- Xuna Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Yiwen Wang
- Xi'an International Medical Center Hospital Affiliated To Northwest University, Xi'an, 710119, China
| | - Lin Shen
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Yating Sun
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Beibei Zeng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Boxu Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Fei Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
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Simon L, Primeaux SD, Levitt DE, Bourgeois B, Johannsen NM, Peters A, Ahmed J, Marshall RH, Fairchild AH, Ferguson TF, Molina PE. An aerobic exercise intervention to improve metabolic health among people living with HIV with at-risk alcohol use: the ALIVE-Ex research study protocol. AIDS Res Ther 2023; 20:35. [PMID: 37296413 PMCID: PMC10251573 DOI: 10.1186/s12981-023-00530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Effective antiretroviral therapy (ART) in people living with HIV (PLWH) has improved life expectancy and increased risk of age-associated cardiometabolic comorbidities. At-risk alcohol use is more frequent among PLWH and increases the risk of health challenges. PLWH with at-risk alcohol use are more likely to meet criteria for prediabetes/diabetes and this is associated with impaired whole-body glucose-insulin dynamics. METHODS The Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions Study (ALIVE-Ex Study, NCT03299205) is a longitudinal, prospective, interventional study to determine the effects of an aerobic exercise protocol on improving dysglycemia among PLWH with at-risk alcohol use. The intervention is a moderate intensity aerobic exercise protocol implemented 3 days per week for 10 weeks at the Louisiana State University Health Sciences Center-New Orleans. Participants who have a fasting blood glucose level between 94 and 125 mg/dl will be enrolled in the study. Oral glucose tolerance tests, fitness assessments, and skeletal muscle biopsies will be performed pre- and post-exercise intervention. The primary outcome is to determine whether the exercise protocol improves measures of whole-body glucose-insulin dynamics, cardiorespiratory fitness, and skeletal muscle metabolic and bioenergetic function. Secondary outcomes are to determine whether the exercise intervention improves cognitive function and overall quality of life. Results generated will demonstrate the effect of exercise on glycemic measures in PLWH with subclinical dysglycemia and at-risk alcohol use. CONCLUSIONS The proposed intervention will also have the potential to be scalable to promote lifestyle changes among PLWH, particularly in underserved communities.
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Affiliation(s)
- Liz Simon
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Stefany D Primeaux
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Danielle E Levitt
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, 79409, USA
| | - Brianna Bourgeois
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Neil M Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Adrianna Peters
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Jameel Ahmed
- Department of Medicine, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Richard H Marshall
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | | | - Tekeda F Ferguson
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
- Department of Epidemiology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Patricia E Molina
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA.
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA.
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